Exam 1 SG Flashcards
anterior compartment
tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus tertius, deep peroneal nerve, anterior tibial artery and vein
lateral compartment
peroneus longus and brevis, superficial peroneal nerve, peroneal artery
superficial posterior compartment
triceps surae
deep posterior compartment
tibialis posterior, flexor digitorum longus, flexor hallucis longus, tibial nerve, posterior tibial artery/vein
ankle articulartions
distal tibiofibular syndesmosis joint
talocrural joint
rear foot articulations
subtalar (talocalcaneal) joint
inferior talus and superior calcaneous
posterior, anterior, and middle
mid foot articulations
talocalcaneonavicular (TCN) joint
calcaneocuboid (CC) joint
forefoot articulations
tarsometatarsal (TMT)
metatarsophalangeal (MTP)
DIP and PIP (4)
talocrural joint
ankle
action
plantarflexion
dorsiflexion
talartarsal joint
foot
action
inversion
eversion
PIP and DIP
toes
action
flexion 2-5
extension 2-5
dorsiflexion
20
firm/hard
plantarflexion
50
firm/hard
inversion
talocrural 5
forefoot 35
firm
eversion
talocrural 5
forefoot 15
hard/firm
anterior drawer
how to perform
positive sign
what pathology
lie in supine, knee joint slightly flexed, ankle joint 10 to 15 PF, grasp patients heel, stabilize leg and draw foot anteriorly
tibia pulls forward
ACL injury
anterior talofibular ligament
posterior drawer
how to perform
positive sign
what pathology
lie in supine, knee joint slightly flexed, ankle joint 10 to 15 PF, grasp patients heel, stabilize leg and draw foot posteriorly
tibia pulls backwards
posterior cruciate ligament
talar tilt (inversion/eversion)
how to perform
positive sign
what pathology
sitting with leg off, PF, grab calcaneous and perform inversion, anatomical position, then go into inversion and eversion, DF and eversion and inversion
pain, excessive gapping
calcaneiofibular and deltoid ligament
kleiger’s test
how to perform
positive sign
what pathology
foot DF and externally rotated
pain
syndesmosis injury
cotton test
how to perform
positive sign
what pathology
stabilize tibia and fibula, lateral translation to foot
translation of 3-5 mm, or clank heard or felt
syndesmosis injury
TMT/midtarsal glide
how to perform
positive sign
what pathology
supine or seated, grasp metatarsal and proximal tarsal bone, anterior and posterior glide,
laxity or decreased mobility
deep transverse metatarsal ligament or interosseous ligament
Valgus/varus
how to perform
positive sign
what pathology
valgus- stabilize, rotate toe out
varus- stabilize, rotate inward
pain or increase laxity
sprain MCL, LCL, avulsion fracture
thompson test
how to perform
positive sign
what pathology
lie face down, feet hand off edge, grab gastroc
no movement in foot
rupture of achilles tendon
tap/percussion test
how to perform
positive sign
what pathology
tap end of long bone
pain
bone fracture
long bone compression
how to perform
positive sign
what pathology
pressing on ends of bone
pain
long bone fracture
tinel’s sign
how to perform
positive sign
what pathology
tap posterior to medial malleolus
tingling or parathesia distally
peripheral nerve injury
homan’s sign
how to perform
positive sign
what pathology
extend knee, raise up to 10 degrees, passively and abruptly DF foot and squeezes calf
deep calf pain and tenderness
deep vein thrombosis
feiss line
how to perform
positive sign
what pathology
draw line between apex of medial malleolus, draw straight line to first MTP joint, find navicular tuberosity, have weight bearing find navicular tuberosity,
navicular tubercle below line
pes planus
navicular drop test
how to perform
positive sign
what pathology
mark navicular tubercle NWB and WB
if more than 1 cm different
pes plansu
interdigital neuroma test
how to perform
positive sign
what pathology
squeeze distal foot together
reproduction of patient’s symptoms
morton’s neuroma
ankle girth test
how to perform
positive sign
what pathology
figure 8 tape measure around ankle
increased measurement on one side
swelling and inflammation
syndesmosis sprain
MOI
signs/symptoms
evaluation techniques
extreme external rotation or DF of talus
pain, inflammation, lack of movement, Kleiger’s test
RICE, NWB, refer to physcian
compartment syndrom
MOI
signs/symptoms
evaluation techniques
acute- blunt force trauma chronic- exertional shiny, weak pulses, AROM decreased, no DF, PF painful, acute- emergency room chronic- IB and stretching
hallux valgus
MOI
signs/symptoms
evaluation techniques
arthritic or metabolic conditions
medially deviation of first metatarsal
insoles, or surgery to fix
mortons neuroma
MOI
signs/symptoms
evaluation techniques
entrapment of common intermetatarsal nerve 3/4, 2/3
pain in traverse arch radiating into toes, PT between MT heads, interdigital neuroma test
refer to Dr. modification of foot wear, orthotics, surgery
plantar faciitis
MOI
signs/symptoms
evaluation techniques
forced DF of ankle w/ toe extension or insidious
pain at calcaneal tubercle radiates distally, worse with WB, PT
orthotics, heel cups/foam, stretching of calr,
stress fracture
MOI
signs/symptoms
evaluation techniques
chronic overuse
insidious, chronic pain, localized pain
PT at fx site, normal ROM,
refer to Dr., won’t show up for 4-6 weeks
os trigonum
MOI
signs/symptoms
evaluation techniques
traumatic, forced hyperPF,
pain deep to the achilles tendon with activity,
swelling over anteromedial and anterolateral to the achilles tendon, pain with palpation over posterior talus, A/P ROM pain w/ PF
PRICE, refer to Dr.
lisfranc injuries
MOI
signs/symptoms
evaluation techniques
foot is in a PF and recieves blow in th heel area axial loading the metatarsals
sever midfoot pain, or paratheisa,
swelling along midfoot, pain WB,
pain control, NWB, refer to Dr.
achilles tendinopathy
MOI
signs/symptoms
evaluation techniques
pain or buring along tendon
repetitive eccentric contraction of gastroc/soleus
PT, crepitus, limited ROM in PF/DF,
NSAIDS, rest, ice, heal lift or cup, immobilization, stretching
lateral bony structure palpation
fibular shaft lateral malleouls lateral border of calcaneous peroneal tubercle cuboid base of 5th metatarsal 5th metatarsal 5th phalange
anterior (dorsal) bony structure palpation
anterior tibial shaft talar dome cuniforms navicular cuboid phalanges
medial bony structure palpation
medial malleolus medial border of calcaneous sustentaculum tali navicular and navicular tubercle medial talar tubercle first cunifrom first metatarsal first MTP joint
posterior bony structure palpation
calcaneous
plantar bony structure palpation
medial calcaneal tubercle
metatarsal heads
sesamoid bone of the great toe
lateral soft tissue palpation
peroneus longus and brevis muscle and tendon peroneous tertius calcaneofibular ligament anterior talofibular ligament posterior talofibular ligament
anterior soft tissue palpation
tibialis anterior extensor hallucis longus tendon extensor retinacula sinis tarsi (extensor digitorum brevis) inferior extensor retinaculum
medial soft structure palpation
deltoid ligament spring ligament tibialis posterior tendon (navicular tubercle) flexor hallucis longus tendon flexor digitorum longus tendon
posterior soft tissue palpation
gastrocnemius- soleus comples
achilles tendon
subcutaneous calcaneal bursa
subtendinous calcaneal bursa
plantar soft tissue palpation
plantar fascia
open pack position of ankle
plantarflexion
closed pack position of ankle
dorsiflexion
medial longitudinal arch function of arch static and dynamic stabilizers what structures runs along
creates space for soft tissues with elastic properties,
calcaneus, talus, navicular, 1 cuniform, 1 metatarsal
plantar calcaneonavicular ligament, deltoid, plantar fascia
lateral longitudinal arch function of arch static and dynamic stabilizers what structures runs along
transmitting weight and makes more contact with the ground
calcaneous, cuboid, 5th metatarsal,
plantar fascia,
transverse arch function of arch static and dynamic stabilizers what structures runs along
muscular support
metatarsal heads extends to calcaneous,
1 and 5 metatarsal heads are WB
windlass effect
medial longitudinal arch
heel to toe, aponeurosis, big toe DF, pulls heel and toe together locks foot
gastrocnemius
insert
origin
action
I- calcaneus via calcaneal tendon
O- condyles of femur, posterior surfaces
A- F knee, PF ankle
soleus
insert
origin
action
I- calcaneus via calcaneal tendon
O- soleal line, proximal, posterior surface of tibia and posterior aspect of the head of the fibula
A- PF ankle
peroneal longus
insert
origin
action
I- bast of 5th metatarsal and medial cuniform
O- head of fibula and proximal 2/3 of lateral fibula
A- Ev foot
peroneal brevis
insert
origin
action
I- tuberosity of 5th metatarsal
O- distal 2/3 of lateral fibula
A- Ev foot
tibialis anterior
insert
origin
action
I- medial cuneiform and distal phalanges of second through 5th toes
O- lateral condyle of tibia; proximal, lateral surface of tibia and interosseous membrane
A- IV foot, DF ankle
tibialis posterior
insert
origin
action
I- all 5 tarsal bones and bases of 2- 4th metatarsal
O- proximal, posterior shafts of tibia and fibula; and interosseous membrane
A- IV foot, PF ankle
extensor digitorum longus
insert
origin
action
I- middle and distal phalanges of 2-5th toes
O- lateral condyle of tibia; proximal shaft of fibula and interosseous membrane
A- Extend 2-5th toes, DF ankle, EV foot
extensor digitorum brevis
insert
origin
action
I- 2-4th toes via extensor digitorum longus tendons
O- dorsal surface of calcaneus
A- Extend 2-4th toes
extensor hallicus longus
insert
origin
action
I- distal phalanx of 1st toe
O- middle, anterior surface of tibia and interosseous membrane
A- Extend 1st toe, DF ankle, IV foot
extensor hallicus brevis
insert
origin
action
I- proximal phalanx of 1st toe
O- dorsal surface of calcaneus
A- Extend 1st toe
flexor digitorum longus
insert
origin
action
I- distal phalanges of 2-5th toes
O- middle, posterior surface of tibia
A- F 2-5th toes, weak PF ankle, IV foot
flexor digitorum brevis
insert
origin
action
I- middle phalanges of 2-5th toes
O- medial process of calcaneus and plantar aponeurosis
A- Flex middle phalanges of 2-5th toes]
flexor hallicus longus
insert
origin
action
I- distal phalanx of 1st toe
O- middle of posterior fibula
A- F 1st toe, weak PF ankle, IV foot
flexor hallicus brevis
insert
origin
action
I- medial and lateral surfaces of base of proximal phalanx of 1st toe
O- plantar surfaces of cuboid and lateral cuniform
A- Flex 1st toe
abductor hallicus
insert
origin
action
I- proximal phalanx of 1st toe and medial sesamoid bone
O- medial process of calcaneus and plantar aponeurosis
A- AB 1st toe
adductor hallicus
insert
origin
action
I- lateral surface of base of proximal phalanx of 1st toe
O- Oblique- bases of 2-5th metatarsals, Transverse- plantar ligament of 3-5th metatarsophalangeal joints
A- AD 1st toe, assist to maintain transverse arch, assist to F 1 toe
hindfoot (rearfoot)
calcaneus
talus
midfoot
navicular
cuniforms (3)
cuboid
forefoot
metatarsals 4
phalanges 14
what causes hammer toe
wearing short, narrow shoes that are too tight
what causes morton’s toe
genetic
1st metatarsal is shorter than 2nd metatarsal
what causes claw toe
nerve damage caused by diseases such as diabetes or alcoholism
how does hammer toe, morton’s toe, and claw toe differ in clinical presentation
claw toe is caused by nerve damage, morton’s toe is genetic, and hammer toe is caused be to tight shoes
what structure pass thorugh tarsal tunnel
tendons of posterior tibialis flexor digitorum longus flexor hallicus longus posterior tibial artery and vein posterior tibial nerve
what parts of foot are weight bearing during gait cycle
1st and 5th metatarsals
calcaneous
different observation/inspection specific to foot and ankle
WB, PWB, NWB antalgic gait ER while walking swelling, ecchymosis, deformity reddened or shiny skin, decreased DF, absent of doralis pedis pulse muscular atrophy new orthotics, changed shoes, shoe condition
ottawa ankle rules
how rules were derived in EBP
patient is unable to walk 4 steps both immediately following injury and at the time or exam
ankle radiography ordered if pain in zone a or b
foot radiography ordered if pain in zone c or d
supination
ankle PF, subtalar IV, forefoot AD
pronation
ankle DF, subtar EV, forefoot AB
types of abnormal gait
what pathology indicated
antalgic (painful) arthrogenic (stiff hip or knee) contracture gait trendelenberg's drop foot
describe how an inter-professional team approach to patient care is beneficial to the patient and patient outcomes
give an example of inter-professional practice
help prevent errors, improves patient experience, and delivers better patient outcomes
and can reduce healthcare costs
a doctor, nurse, pharamcist, and physical therapist work together to help a patient get better
ankle ligaments
lateral- anterior talofibular ligament calcaneofibular ligament posterior talofibular ligament medial deltoid ligaments
Tom, Dick, and Nervous Harry
tibialis posterior flexor digitorum longus tibial artery tibial nerve flexor hallius longus
pulses
posterior tibial artery
dorsalis pedis artery
function of foot
acts as a base of support necessary for maintaining upright posture
provides flexibility to adapt to uneven terrain
aids in shock absorption
acts as a lever during push off
pes cavus
high arch
pes planus
flat foot
main phases of gait
stance phase
swing phase
stance phase
sub phases
heel strike/ initial contant- rigid and supinated
foot flat/ load response
midstance/single leg stance- flexible and pronated
terminal stance/ heel off
toe off/ preswing
swing stance
sub phases
pressing
initial swing
midswing
terminal swing
initial contact
anterior tibialis eccentric contraction
mid stance
gastroc eccentric contraction
terminal stance
gastroc concentric contraction
preswing
gastoc concentric contraction
antalgic (painful)
injury to pelvis, hip, knee, ankle or foot
effected leg stance phase is short than other leg
arthrogenic (stiff knee or hip)
stiffness, laxity, or deformity
can be painful
lift entire leg higher than normal to clear the ground
contracture gait
if the person was in a cast or brace for a long time,
trendelenbergs
contralateral side droops
drop foot gait
weak or paralyzed DFs results in drop foot, to compensate the knee is lifted higher than normal, foot will slap ground
syndesmosis structures
anterior inferior tibiofibular ligament
posterior inferior tibiofibular ligament
interosseous ligament
interosseous membrane
